Despite media reports and educators' concerns, no substantive data exist to document or refute the emerging reports that children prenatally exposed to cocaine have serious behavioral problems in school. The urgency of this problem is magnified by the large number of prenatal cocaine- exposed children entering elementary school. The Primary Aim of this four- year study is to determine if a relationship exists between prenatal cocaine/alcohol exposures and school behavior and, if so, to determine if the relationship is characterized by a dose-response. A Secondary Aim will evaluate the relationship between prenatal cocaine/alcohol exposures and school achievement. Both relationships will be assessed in a black, urban sample of first grade students using multivariate statistical techniques for confounding as well as mediating and moderating, prenatal and postnatal variables. A Third Aim is to evaluate the relationship between a general standardized classroom behavioral measure and a tool designed to tap the effects thought to be specific to prenatal cocaine exposure. This interdisciplinary research team can address these aims because of the existence of a unique, prospectively-collected Perinatal Database, funded in part by NIAAA and NICHD. The Database includes repeated measures of cocaine, alcohol, and other substances for over 3500 births since 1986. Information from this database will be combined with information from the database of one of the largest public school systems in the nation. The sample is composed of 1004 first grade students for whom the independent variables, prenatal cocaine/alcohol exposures were prospectively assessed and quantified at the University maternity center. After informed consent the Primary dependent variable, school behavior, will be assessed, using the Problem Behavior Scale (a teacher consensus-developed instrument) and the Conners' Teacher Rating Scale. The secondary dependent measure, school achievement, will be measured by the Metropolitan Achievement Test. All analyses will be adjusted as appropriate for these following control variables: perinatal factors (perinatal risk, neonatal risk, other prenatal drug and cigarette exposure); postnatal exposures (cocaine/alcohol, other drugs, and cigarettes); postnatal maternal and home environmental factors, including support (Norbeck Social Support Questionnaire), child guardianship (history), attitudes toward parenting (Parental Stress Index), family functioning (FACES-II), maternal IQ (PPVT- R; WAIS-R subscales) and the home (HOME) and neighborhood environment (an adaptation from the Robert Wood Johnson Foundation Infant Follow-Up). To adequately understand the relationship between the dependent variables, measures of covariates (child IQ) and potential mediators (child growth, speech and hearing) will also be assessed. The strengths of this study are the availability of a unique Perinatal Database, the availability of information from a school database, maintenance of confidentiality, reliable measures of exposures across pregnancy, and a screening tool specific to the problem school behaviors thought to be associated with prenatal cocaine exposure by teacher-consensus.